Provider Demographics
NPI:1063605210
Name:TERHEYDEN, MELEAH CHAMBERLAIN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELEAH
Middle Name:CHAMBERLAIN
Last Name:TERHEYDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MELEAH
Other - Middle Name:MAY
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:445 BELLEVUE AVENUE
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612
Mailing Address - Country:US
Mailing Address - Phone:510-506-3076
Mailing Address - Fax:510-269-9031
Practice Address - Street 1:445 BELLEVUE AVENUE
Practice Address - Street 2:SUITE 101A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612
Practice Address - Country:US
Practice Address - Phone:510-506-3076
Practice Address - Fax:510-269-9031
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS277911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical